Christian Wolfram

Increasing Prevalence of Myopia in Europe and the Impact of Education

Purpose To investigate whether myopia is becoming more common across Europe and explore whether increasing education levels, an important environmental risk factor for myopia, might explain any temporal trend. Design Meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E3) Consortium. Participants The E3 Consortium is a collaborative network of epidemiological studies of common eye diseases in adults across Europe. Refractive data were available for 61 946 participants from 15 population-based studies performed between 1990 and 2013; participants had a range of median ages from 44 to 78 years. Methods Noncycloplegic refraction, year of birth, and highest educational level achieved were obtained for all participants. Myopia was defined as a mean spherical equivalent ≤−0.75 diopters. A random-effects meta-analysis of age-specific myopia prevalence was performed, with sequential analyses stratified by year of birth and highest level of educational attainment. Main Outcome Measures Variation in age-specific myopia prevalence for differing years of birth and educational level. Results There was a significant cohort effect for increasing myopia prevalence across more recent birth decades; age-standardized myopia prevalence increased from 17.8% (95% confidence interval [CI], 17.6–18.1) to 23.5% (95% CI, 23.2–23.7) in those born between 1910 and 1939 compared with 1940 and 1979 (P = 0.03). Education was significantly associated with myopia; for those completing primary, secondary, and higher education, the age-standardized prevalences were 25.4% (CI, 25.0–25.8), 29.1% (CI, 28.8–29.5), and 36.6% (CI, 36.1–37.2), respectively. Although more recent birth cohorts were more educated, this did not fully explain the cohort effect. Compared with the reference risk of participants born in the 1920s with only primary education, higher education or being born in the 1960s doubled the myopia prevalence ratio–2.43 (CI, 1.26–4.17) and 2.62 (CI, 1.31–5.00), respectively—whereas individuals born in the 1960s and completing higher education had approximately 4 times the reference risk: a prevalence ratio of 3.76 (CI, 2.21–6.57). Conclusions Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor. Increasing levels of myopia carry significant clinical and economic implications, with more people at risk of the sight-threatening complications associated with high myopia.

Prevalence of refractive errors in the European adult population: the Gutenberg Health Study (GHS)

Objective To study the distribution of refractive errors among adults of European descent. Design Population-based eye study in Germany with15 010 participants aged 35–74 years. Methods The study participants underwent a detailed ophthalmic examination according to a standardised protocol. Refractive error was determined by an automatic refraction device (Humphrey HARK 599) without cycloplegia. Definitions for the analysis were myopia <−0.5 dioptres (D), hyperopia >+0.5 D, astigmatism >0.5 cylinder D and anisometropia >1.0 D difference in the spherical equivalent between the eyes. Exclusion criterion was previous cataract or refractive surgery. Results 13 959 subjects were eligible. Refractive errors ranged from −21.5 to +13.88 D. Myopia was present in 35.1% of this study sample, hyperopia in 31.8%, astigmatism in 32.3% and anisometropia in 13.5%. The prevalence of myopia decreased, while the prevalence of hyperopia, astigmatism and anisometropia increased with age. 3.5% of the study sample had no refractive correction for their ametropia. Conclusions Refractive errors affect the majority of the population. The Gutenberg Health Study sample contains more myopes than other study cohorts in adult populations. Our findings do not support the hypothesis of a generally lower prevalence of myopia among adults in Europe as compared with East Asia.

Distribution of central corneal thickness and its association with ocular parameters in a large central European cohort: the Gutenberg health study.

Main objective To evaluate the distribution of central corneal thickness (CCT) in a large German cohort and to analyse its relationship with intraocular pressure and further ocular factors. Design Population-based, prospective, cohort study. Methods The Gutenberg Health Study (GHS) cohort included 4,698 eligible enrollees of 5,000 subjects (age range 35–74 years) who participated in the survey from 2007 to 2008. All participants underwent an ophthalmological examination including slitlamp biomicroscopy, intraocular pressure measurement, central corneal thickness measurement, fundus examination, and were given a questionnaire regarding glaucoma history. Furthermore, all subjects underwent fundus photography and visual field testing using frequency doubling perimetry. Results Mean CCT was 557.3±34.3 µm (male) and 551.6±35.2 µm in female subjects (Mean CCT from right and left eyes). Younger male participants (35–44 years) presented slightly thicker CCT than those older. We noted a significant CCT difference of 4 µm between right and left eyes, but a high correlation between eyes (Wilcoxon test for related samples: p<0.0001). Univariable linear regression stratified by gender showed that IOP was correlated with CCT (p<0.0001). A 10 µm increase in CCT led to an increase in IOP between 0.35–0.38 mm Hg, depending on the eye and gender. Multivariable linear regression analysis revealed correlations between gender, spherical equivalent (right eyes), and CCT (p<.0001 and p = 0.03, respectively). Conclusions We observed positive correlations between CCT and IOP and gender. CCT was not correlated with age, contact lens wear, positive family history for glaucoma, lens status, or iris colour.

Health- and Vision-Related Quality of Life in Patients with Ocular Hypertension or Primary Open-Angle Glaucoma

Background: The main objective of this analysis was to assess the impact of severity of disease on the quality of life (QoL) of patients with ocular hypertension (OHT) and early, moderate, or advanced primary open-angle glaucoma (POAG). Methods: This multicenter study was conducted at 2 university hospitals and 13 ophthalmology practices in Germany. QoL data were assessed by the Health Utility Index (HUI3) and the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Results: 154 patients (17.5% OHT, 27.9% early, 22.7% moderate, and 31.8% advanced POAG) were included. The HUI3 scores for OHT, early, moderate, and advanced POAG were 0.87 ± 0.09, 0.85 ± 0.15, 0.75 ± 0.23, and 0.58 ± 0.32, respectively. Compared to a normal population matched by age and gender, for moderate and severe POAG a difference of -0.06 ± 0.24 and -0.19 ± 0.28, respectively, was observed. NEI-VFQ-25 scores illustrate different dimensions of the impact on QoL; reduced peripheral vision or difficulties to drive a car were more crucial to glaucoma patients than social factors. Conclusions: The key difference for QoL impairment in glaucoma lies between OHT/early POAG versus moderate/severe POAG, hence every possible effort needs to be made to prevent disease progression over this threshold.

Blindness and Low Vision in Germany 1993–2009

Purpose: To describe the development of the prevalence of blindness and low vision in the German population between 1993 and 2009 with respect to major demographic changes and to investigate how the prevalence of blindness would have developed without demographic aging. Methods: Investigation of the prevalence for blindness and low vision in the German population on the basis of the official German statistics for severely handicapped people and population statistics between 1993 and 2009. Age-specific prevalence rates and the prevalence based on a standardized population were calculated and the progression is demonstrated. Results: The overall prevalence of blindness and low vision in Germany increased between 1993 and 2009 by 12.3% from 314,404 to 352,943 subjects. The absolute number of blind or visually impaired persons in the eldest group (75 years and above) has grown by 38.2% from 126,023 to 174,127 subjects. At the same time, both age-specific prevalence rates as well as the prevalence that was based on a standardized population decreased, matching more than 30,000 fewer cases of blindness in 2009 as compared to 1993. Conclusions: The increase in absolute prevalence numbers for blindness and low vision implies an increase in the ophthalmic workload. At the same time, the decrease in the age-specific and standardized prevalence indicates possible improvements in the overall eye health status of the population since 1993.